Views on New Grads Entering the ER.
- page 2

hi all... i am in my final semester on nursing school!! my graduation is august 10th! woohoo ... sorry i am so excited!
i am doing a school project on new grads entering the er. i would like your... Read More

I started working in the ER after working a year on a cardiac telemetry floor. I initially wanted to work in the ER right after school, but I am glad that I chose not to. I think that it is okay to work in the ER as a new grad if you have a background dealing with the emergency department (EMT, ED tech, Paramedic, etc), but it would be harder for the person who hasn't. It also takes a strong personality and like someone said before, you are either a ER nurse or not. It is very easy to weed out the ones who aren't strong enough for the job in a month or two.

I started in the ER as a new grad a year and a half ago, and I absolutely love it. There are a difference of opinions...some nurses say...u must have experience before entering a critical care setting...and other say...u learn as you go. From my experience, as a new grad, you are willing to learn anything and everything. You are motivated. I didn't have a very long orientation at all because we were sooo short on nurses. However, I am a fast learner so I learned as I went. I still ask questions when I don't know something. You don't experience every scenario in your first few months of orientation. That's what's great about the ER....new scenarios all the time. However, you must have a strong orientation to get a base!!! I hope this helps.

I am now working as an Agency Nurse at different ER's, and I don't think I like it very much. I was given 3 patients after 2 hrs. of mini-orientation(going over basic charting) and was cancelled 2 out of the 3 days I signed up. I hope it gets better. If anyone has an input on this, pls let me now.

From past experience using many agency nurses over many years both as charge nurse and Clinical Leader, I have found that the nurses that have had at least 3-4 years experience in a stable ER environment that they are comfortable with and can grow in, adjust to being agency nurses much better. It is very seldom that we get an agency or traveler with less than 2 years experience that works out for us. I'm not saying that no-one can do it, it's just that from an employers point of view the expectation is that an agency or traveling nurse should be able to "hit the floor running". We ask them to come in 1 hour before their first shift to do a computer learning packet (We are phasing in CPOE) and then we buddy them with one of our nurses for 4 hours. After that they are on their own.

From a personal view point, I give agency/travelers all the credit in the world. I've been an ER Nurse for over 20 years and could not imagine going into a strange ER with a patient population I don't know and ED Doc's I don't know. I personally could never do it. I need to be comfortable in my surroundings and know which Doc's to completely truat and which to question.

As a new grad- i have a follow up question: i precepted in the ER my last quarter of school, and i fell in LOVE with the dynamics and teamwork that i saw (the best i've ever seen in any dept). here's my prob, applying for jobs now, i've been told in almost every place that at least a year of floor experience is required for ER positions around here, what dept should i try to get into to provide the most used and valuable knowledge needed in the ER? are they all similar, or should i take cardiac/tele, or should reg. med surg work>? i have been working as an LPN in chemical dependency for a year, and i know that is gonna help! but i want to be planning ahead and preparing myself in the best way to excel in the ER later on. Thanks!

Congratulations on your upcoming graduation!!
If ER nursing is what you want do do, then go for it!!
The ER I'm at now (Level I) just hired 20 new grads! I started in the ER as a new grad 3 years ago, and I love it. I did my first year as a staff nurse, then worked some agency and traveled as soon as I got the 1 year under my belt.

In the ER, you will learn about all different adult injuries and illnesses, especially if your employer wants you to take advantage of workshops and seminars out there. Your veteran nurses will be able to mentor you as well. In my experience the area of nursing expertise which is the least common and therefore the most valuable is labor and delivery as well as pediatrics---mainly infants and newborns. The nurses who work in L and D, and peds must stay there forever because I rarely met one in the ER. You'll always find an ex-CCU, SICU or med-surg nurse in the ER and it's great to have that expertise available, but nurses that know how to care for a precipitously born baby in distress or a woman about to give birth are about as common as hen's teeth.

Hi,
When I graduated from diploma school in 1967, I had been working in the er on the weekends during my senior yr. I loved it and that became my life for the next 20 yrs! However, at that time, as a new diploma grad you had been exposed to great more clinical experiences, than new grads w adn and bsn grads today. I recall when I had a new bsn grad and asked her to obtain a cath ua. 30 min later it had still had not been done and when I asked her about it, she hung her head and said that she had NEVER catheterized anyone before! I was shocked and immediately called the education dept and told them. Never did I want a new grad w no experience in my er again. Soon, thereafter, they in all their wisdom, developed an internship program for all new grads hired on in the hospital. Needless to say, I am against new grads in the er, if they are not diploma grads and they are, sadly, few and far between now. Too bad.....

Hi,
When I graduated from diploma school in 1967, I had been working in the er on the weekends during my senior yr. I loved it and that became my life for the next 20 yrs! However, at that time, as a new diploma grad you had been exposed to great more clinical experiences, than new grads w adn and bsn grads today. I recall when I had a new bsn grad and asked her to obtain a cath ua. 30 min later it had still had not been done and when I asked her about it, she hung her head and said that she had NEVER catheterized anyone before! I was shocked and immediately called the education dept and told them. Never did I want a new grad w no experience in my er again. Soon, thereafter, they in all their wisdom, developed an internship program for all new grads hired on in the hospital. Needless to say, I am against new grads in the er, if they are not diploma grads and they are, sadly, few and far between now. Too bad.....

I think it is pretty ridiculous to say "no new grads unless they're diploma grads." That would be like me saying "I only want to work with other BSNs because at least THEY have a 4 year degree" (which I would never say). It is unfortunate that one unprepared new grad has soured your view on new grads forever. I had a checklist of things I HAD to master before graduating - and if I didn't prove I could do them on at least 1 live person, I wouldn't graduate. This included caths, IVs, NGs, etc.

The hospital where I work has a fellowship for every specialty....if you are a new grad, you don't just get an orientation to the unit and start working, you go through a 12-20 week fellowship (less time for med surg, the full 20 for ER) with classes and precepted caregiving in your unit. That means that for 20 weeks, I worked 40 hours in the ED with someone looking over my shoulder - she didn't take her own patients, she was just there to make sure I was doing okay and that my patients were okay as well.

I don't think ANY new grad should be thrown into direct patient care. At least, not until nursing education changes to be more in line with "true" nursing as opposed to "pie in the sky" nursing. Maybe a combination of the philosophies of the BSN and diploma programs would be called for - the educational aspects and background of the BSN combined with the clinical hours of the diploma.

And as an aside, I was visiting my grandmother on a med surg floor after abd surgery. The nurse, very nice, was giving my grandmother her meds - Gran had been dx with CHF recently, and didn't understand why she was taking the Lasix. The nurse could only tell her "it makes you pee more" she wasn't able to get into the patho of "weak heart, fluid backs up, the Lasix helps pull the fluid out of your kidneys etc etc etc". She said "it is the doctor's job" to explain the medical background. I asked her where she went to school, and she named a diploma school in the area.
I'm sure glad I didn't make a generalization of all diploma nurses based on the actions of that one.

I recall when I had a new bsn grad and asked her to obtain a cath ua. 30 min later it had still had not been done and when I asked her about it, she hung her head and said that she had NEVER catheterized anyone before! I was shocked and immediately called the education dept and told them. .....

Perhaps offering to show her once--which is probably all it would have taken and in less than 5 minutes---would've been less work for you than stomping down the hall to make your phone call of righteous indignation......

What a nice object lesson about nursing in general for that new nurse:angryfire

I think it is pretty ridiculous to say "no new grads unless they're diploma grads." That would be like me saying "I only want to work with other BSNs because at least THEY have a 4 year degree" (which I would never say). It is unfortunate that one unprepared new grad has soured your view on new grads forever. I had a checklist of things I HAD to master before graduating - and if I didn't prove I could do them on at least 1 live person, I wouldn't graduate. This included caths, IVs, NGs, etc.

The hospital where I work has a fellowship for every specialty....if you are a new grad, you don't just get an orientation to the unit and start working, you go through a 12-20 week fellowship (less time for med surg, the full 20 for ER) with classes and precepted caregiving in your unit. That means that for 20 weeks, I worked 40 hours in the ED with someone looking over my shoulder - she didn't take her own patients, she was just there to make sure I was doing okay and that my patients were okay as well.

I don't think ANY new grad should be thrown into direct patient care. At least, not until nursing education changes to be more in line with "true" nursing as opposed to "pie in the sky" nursing. Maybe a combination of the philosophies of the BSN and diploma programs would be called for - the educational aspects and background of the BSN combined with the clinical hours of the diploma.

And as an aside, I was visiting my grandmother on a med surg floor after abd surgery. The nurse, very nice, was giving my grandmother her meds - Gran had been dx with CHF recently, and didn't understand why she was taking the Lasix. The nurse could only tell her "it makes you pee more" she wasn't able to get into the patho of "weak heart, fluid backs up, the Lasix helps pull the fluid out of your kidneys etc etc etc". She said "it is the doctor's job" to explain the medical background. I asked her where she went to school, and she named a diploma school in the area.
I'm sure glad I didn't make a generalization of all diploma nurses based on the actions of that one.

on the general description of lasix - lol - i have many times had to say just that - when one tries to explain in depth to many older patients they either do not want to hear it or do not "get it" so its best to keep it simple is what i have found - however - i have no trouble explaining it to the family who can understand it. i know my grandma knows that her lasix makes her pee more and she knows it is to prevent her from going back to the hospital - she is 90 and that's all she cares to know - many of our elderly are still in the era of they trust their docs implicitly ( whether they should or not ) and do what they are told and dont ask dont wanna know. just what i have seen in my area.